Math Donation Form

By completing this form, I agree to submit my donation to the CT scanner project for Mission Memorial Hospital. Tax receipts will be provided by the Fraser Valley Health Care Foundation (FVHCF).

Please submit this form to Mission Altogether for Healthcare (MATH) or to the Fraser Valley Health Care Foundation.

Full Name of Individual or Organization Name

Address

City

Province

Postal Code

Telephone

I want to make a donation now in the amount of $

You have my permission to publicly recognize me as a donor.

Fraser Valley Health Care Foundation:

I enclose my cheque payable to Fraser Valley Health Care Foundation Mail to: FVHCF, 7324 Hurd Street, Mission, BC, V2V 3H5

Please Charge My
VisaMasterCardE-transfer: info@fvhcf.ca

Card Number

Expiry date (MM/YY)

CVC

Name On Card

Signature
I agree for FVHCF to process my credit for the above amount.

THE DONOR AGREES TO THE TERMS OF PAYMENT CONTAINED ABOVE.

Signature
I agree for FVHCF to process my credit for the above amount.

Date

ABOUT MATH

Our organization, a registered society, Mission Altogether for Healthcare (MATH), was formed to ensure our growing community of Mission, in the province of British Columbia, receives the healthcare resources it requires now and in the future.

CONTACT MATH

JOIN OUR ORGANIZATION

One of our Volunteers will contact you about joining our Organization and helping our great cause.